Routine inspection·September 18, 2023

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 9/18/23 at approximately 10:00am, and met with Licensee/Administrator Norbert Sacro. LPA observed two caregivers on duty during the inspection. Facility has an emergency disaster plan as required. Facility has an infection control plan as required. There are currently six(6) residents in care. The LPA reviewed six (6) resident files. The LPA reviewed four (4) staff files. All staff have criminal record clearance as required. Administrator Norbert Sacro has a current administrator certificate- expires 10/31/2024. LPA toured the facility with the Administrator. All exits were free and clear of obstruction. All exit doors had auditory alarms and the alarms were working properly during the inspection. Fire extinguishers, two(2), were serviced and tagged as required, expires 7/1/24. Facility was at a comfortable temperature; LPA observed three residents watching tv upstairs in the living room. LPA observed one resident eating their meal in the downstairs common area room. LPA observed two resident rooms upstairs, and two resident rooms downstairs. On each floor one of the resident rooms is a shared room. There was a sufficient supply of hygiene products, cleaning supplies, and paper products for use as needed. Facility has a sufficient supply of personal protective equipment(PPE) for use as needed. LPA observed sufficient supply of food, perishable and non-perishable. Medications were stored and locked making them inaccessible to residents. All toxins and cleaners were stored in locked cabinets, and inaccessible to residents in care. LPA is requesting the following documents be updated and submitted by 10/18/23: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to provide all information in all boxes as required) Infection Control Plan-Updated Copy of LIC400 Handling of Client Cash Resources- complete and submit Include copy of surety bond (if handling cash) Copy of Current Liability Insurance Copy of current Administrator Certificate Continued on LIC809C... Per file review and observations by the LPA, facility is fire cleared for four ambulatory, and two(2) non-ambulatory only. Licensee has a two additional non-ambulatory residents, and a bedridden resident admitted into the facility, which is out of compliance with the approved fire clearance. This deficiency will be cited, .Fire Clearance 87202(a) -All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal, see LIC809D. Per record review, three out of four staff/caregivers lack current First Aid; Three out of four staff lack current CPR certification. All caregivers must have First Aid and one person on each shift must have CPR. This deficiency will be cited, HSC 1569.618(c )(3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times, see LIC809D. LPA observed a resident room to have a strong urine odor as soon as the resident's door was opened. This deficiency will be cited, Managed Incontinence 87625(b)(3)- Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence, see LIC809D. LPA observed that two resident rooms with very dirty carpet, one room is on the upstairs level, and the other is on the downstairs level. This deficiency will be cited, Maintenance and Operation 87303(a) - The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. Per record reviews, Three out of Four staff lack required annual training. This deficiency will be cited, H&S 1569.625(b)(2) - In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, see LIC809D. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited, see LIC809D pages. Failure to correct deficiencies by due dates, may result in additional deficiency citations and/or civil penalties being assessed. Exit interview conducted with the Administrator Norbert Sacro. Appeal Rights provided.